A nurse is preparing to check a client's blood pressure. Which of the following actions should the nurse take?

Use a cuff with a width that is about 60% of the client's arm circumference.

Release the pressure on the client's arm 5 to 6 mm per second.

Apply the cuff above the client's antecubital fossa

Have the client sit with his arm resting above the level of his heart.

Answer and Explanation

Correct Answer : A,B

A cuff that is too narrow or too wide can result in inaccurate blood pressure readings. The cuff should be snug but not tight and cover about 80% of the arm length. The pressure should be released at a rate of 2 to 3 mm per second to avoid missing auscultatory gaps or causing discomfort to the client.

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Correct Answer is A

Explanation

Assist the client with a bowel cleansing. The rationale for this answer is that an IVP is a diagnostic test that uses an intravenous contrast agent and x-rays to visualize the urinary tract structures and function. A bowel cleansing is necessary before the procedure to eliminate fecal matter that may obscure the images or interfere with contrast excretion.

A. Change the PN infusion bag every 48 hr. B. Administer the PN and fat emulsion separately. C. Prepare the client for a central venous line. D. Obtain a random blood glucose daily.

Correct Answer is C

Explanation

Rationale: Parenteral nutrition (PN) is a method of providing essential nutrients to the body through a central vein. PN is indicated for clients who cannot take oral or enteral nutrition due to intestinal failure or other conditions. PN requires a central venous line because the solution is hypertonic and can cause thrombophlebitis or damage to peripheral veins. A central venous line also allows for better monitoring of fluid balance and electrolyte levels.

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A nurse is preparing to check a client's blood pressure. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning care for a client who is scheduled for an intravenous pyelogram (IVP). Which of the following actions is appropriate for the nurse to include?

Correct Answer is A

Explanation

A nurse is planning care for a client who has a new prescription for parenteral nutrition (PN) in 20% dextrose and fat emulsions. Which of the following is an appropriate action to include in the plan of care?

Correct Answer is C

Explanation

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